| Entity Name: | PAULETTE GOPMAN PERLOWIN LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Oct 2021 (3 years ago) |
| Document Number: | L21000464808 |
| FEI/EIN Number | 87-3263703 |
| Address: | 4291 NW 1ST DR., DEERFIELD BEACH, FL 33442 UN |
| Mail Address: | 4291 NW 1ST DRIVE, DEERFIELD BEACH, FL 33442 UN |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780337329 | 2022-02-03 | 2022-02-03 | 4291 NW 1ST DR, DEERFIELD BEACH, FL, 334429245, US | 4291 NW 1ST DR, DEERFIELD BEACH, FL, 334429245, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-471-2801 |
| Fax | 9545311708 |
Authorized person
| Name | MS. PAULETTE G PERLOWIN |
| Role | NURSE PRACTITIONER, OWNER |
| Phone | 9544712801 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 768217400 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1639230899 |
| Name | Role | Address |
|---|---|---|
| PERLOWIN, PAULETTE G | Agent | 4291 NW 1ST DR., DEERFIELD BEACH, FL 33442 |
| Name | Role | Address |
|---|---|---|
| PERLOWIN, PAULETTE G | Manager | 4291 NW 1ST DR., DEERFIELD BEACH, FL 33442 UN |
| Name | Role | Address |
|---|---|---|
| PERLOWIN, GARY | Authorized Person | 4291 NW 1ST DR., DEERFIELD BEACH, FL 33442 UN |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-20 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-05-01 |
| Florida Limited Liability | 2021-10-26 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
